Download Orthopedic Center Hand and Orthopedic Upper Extremity Program

Orthopedic Center ­
Hand and Orthopedic Upper Extremity Program
Arthrygroposis
Whether your child or loved one suffers a broken arm, a sports-related injury or the most complex spine condition,
the Orthopedic Center at Boston Children’s Hospital is committed to providing comprehensive and compassionate care.
Established in 1903, we are among the world’s most experienced pediatric orthopedic programs, treating a high volume
of some of the most complex orthopedic conditions. And with 13 specialty clinics, we are the largest in the country. We
are also one of the busiest. Each year, our staff attends to about 100,000 patient visits and conducts about 6,000 surgeries.
The Hand and Orthopedic Upper Extremity Program provides comprehensive care for infants, children and adolescents with a wide
range of complex upper limb conditions. Multidisciplinary care involving occupational and physical therapy, splinting, casting and
reconstructive surgeries is provided for congenital, neuromuscular, sports-related oncologic, traumatic or post-traumatic conditions.
What is Arthrogryposis?
Arthrogryposis is a term used to describe a number of rare,
non-progressive conditions characterized by stiff joints and
abnormal muscle development. It is also referred to as
arthrogryposis multiplex congenita or amyloplasia.
How is arthrogyposis treated?
Early in life, patients with joint abnormalities are typically
treated with stretching exercises and splinting to improve motion.
Splinting and occupational/hand therapy are the treatment of
choice for patients with mild to moderate deformity.
What causes arthrogryposis?
The exact cause of arthrogryposis is unknown, though
a number of different theories have been proposed. Some
believe that arthrogryposis is caused by mechanical obstructions to
intrauterine movement during pregnancy. Others believe that it
may be a result of an early viral infection during development.
Still others believe that arthrogryposis is the result of failure of
the central nervous system and/or muscular system to develop
appropriately. Arthrogryposis is not thought to be a genetic or
hereditary condition.
Some patients may have persistent functional difficulties despite a rigorous physical therapy regimen. In certain situations, surgery is recommended to improve limb position and function. These procedures may include muscle
releases, tendon transfers, or bony fusions. Posterior elbow release and triceps lengthenings, for example, may be
performed after two years of age in improve elbow flexion.
How common is arthrogryposis?
Arthrogryposis is a rare condition, though the exact frequency
with which it occurs is unknown. Previous studies have estimated
that it affects one to three of every 10,000 live births.
How is arthrogyposis diagnosed?
Arthrogryposis is diagnosed by treating physicians after a
thorough medical history and careful physical examination.
X-rays are often taken to confirm the diagnosis and to evaluate
stiff or dislocated joints. Additional tests, including blood tests,
muscle biopsies, and other imaging studies, are often used to
further make the diagnosis. Patients with arthrogryposis often have
involvement of the upper limbs. Typically, these patients will
have shoulders that are internally rotated and adducted, elbows
that are stiff in extension or flexion, and wrists and fingers that
are flexed.
Tendon transfers to restore active elbow flexion may be
considered in some children after five to seven years of
age. Wrist flexion deformities may be treated with tendon
transfers and/or bony procedures to change the alignment
of the wrist. Finally, surgical procedures to rearrange the skin
between the thumb and index finger may benefit selected patients
with tightness between the thumb and palm. While improvements can be made, most patients will have persistent muscular
and/or joint limitations due to the underlying condition.
Clinical
Team
Clinical Team
Locations
Locations
Peter M. Waters, MD
Peter M. Waters, MD
Donald S. Bae, MD
Donald S. Bae, MD
Carley Vuillermin, MBBS, FRACS
Carley Vuillermin, MBBS, FRACS
Andrea Bauer, MD
Andrea Bauer, MD
Jessica Burns, NP
Jessica Burns, NP
Paula Donahue, RN, BSN
Paula Donahue, RN, BSN
Laurie Travers, RN
Laurie Travers, RN
Boston Children’s Hospital
Boston
Children’s
Hospital
300
Longwood
Avenue
300
Longwood
Avenue
Boston,
MA 02115
Boston, MA 02115
Boston Children’s at Lexington
Boston
Children’s
482
Bedford
Streetat Lexington
482
Bedford
Street
Lexington,
MA
02420
Lexington, MA 02420
Boston Children’s at Waltham
Boston
at Waltham
9 Hope Children’s
Avenue
9 Hope Avenue
Waltham,
MA 02453
Waltham, MA 02453
Boston Children’s at Peabody
Boston
Children’s
10 Centennial
Driveat Peabody
10 Centennial
Drive
Peabody,
MA 01960
Peabody, MA 01960
Call 617-355-6021 to schedule an appointment | childrenshospital.org/hand